European Stroke Journal最新文献

{"title":"Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I).","authors":"Christoph Riegler, Regina von Rennenberg, Kerstin Bollweg, Eberhard Siebert, Gian Marco de Marchis, Georg Kägi, Pasquale Mordasini, Mirjam R Heldner, Mauro Magoni, Alessandro Pezzini, Alexander Salerno, Patrik Michel, Christoph Globas, Susanne Wegener, Nicolas Martinez-Majander, Sami Curtze, Maria Luisa Dell'Acqua, Guido Bigliardi, Nabila Wali, Paul J Nederkoorn, Dejana R Jovanovic, Visnja Padjen, Issa Metanis, Ronen R Leker, Giovanni Bianco, Carlo W Cereda, Rosario Pascarella, Marialuisa Zedde, Maria Maddalena Viola, Andrea Zini, João Nuno Ramos, João Pedro Marto, Heinrich J Audebert, Simon Trüssel, Henrik Gensicke, Stefan T Engelter, Christian H Nolte","doi":"10.1177/23969873241278948","DOIUrl":"10.1177/23969873241278948","url":null,"abstract":"<p><strong>Background: </strong>Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.</p><p><strong>Methods: </strong>A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.</p><p><strong>Results: </strong>Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.</p><p><strong>Conclusion: </strong>EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241278948"},"PeriodicalIF":5.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic drugs for carotid artery dissection: Updated systematic review.","authors":"Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter","doi":"10.1177/23969873241292278","DOIUrl":"10.1177/23969873241292278","url":null,"abstract":"<p><strong>Introduction: </strong>Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.</p><p><strong>Patients and methods: </strong>Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.</p><p><strong>Results: </strong>We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (OR_all-studies 2.70, 95% CI 1.27-5.72; OR_RTCs 6.80, 95% CI 0.14-345; OR_{non-randomized studies} 2.60, 95% CI 1.20-5.60) and death or disability (OR_all-studies 2.1, 95% CI 1.58-2.66; OR_RTCs 2.2, 95% CI 0.29-16.05; OR_{non-randomized studies} 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (OR_RTC 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (OR_all-studies 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (OR_all-studies 0.17, 95% CI 0.03-1.03).</p><p><strong>Discussion and conclusion: </strong>The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241292278"},"PeriodicalIF":5.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis or antiplatelet therapy for acute nondisabling ischemic stroke: A systematic review and network meta-analysis.","authors":"François Lun, Lina Palaiodimou, Aristeidis H Katsanos, Georgios Tsivgoulis, Guillaume Turc","doi":"10.1177/23969873241293323","DOIUrl":"10.1177/23969873241293323","url":null,"abstract":"<p><strong>Purpose: </strong>Uncertainties remain on the optimal treatment for acute minor stroke with nondisabling symptoms. The two most common therapeutic approaches are intravenous thrombolysis (IVT) and antiplatelet therapy, notably dual antiplatelet therapy (DAPT). We synthesized data from the literature to compare IVT to DAPT and identify the best treatment for this population.</p><p><strong>Method: </strong>We systematically searched Pubmed, Web of Science and the Cochrane Library for randomized trials and observational studies comparing IVT, aspirin, and/or DAPT, started within 24 h of symptom onset in patients with minor stroke (NIHSS ⩽ 5) and nondisabling symptoms. Random-effects Bayesian network meta-analysis was conducted. The primary outcome was excellent functional outcome at 3 months (mRS 0-1). Secondary outcomes included mRS 0-2, symptomatic intracranial hemorrhage, mortality, and recurrent stroke.</p><p><strong>Findings: </strong>Four randomized trials and 2 observational studies (5897 patients for the analysis of the primary outcome) were included. Compared with IVT (alteplase), DAPT (clopidogrel + aspirin) was significantly associated with higher odds of mRS 0-1 (OR = 1.52, 95% CrI, 1.09-2.35), but aspirin alone was not (OR = 1.36, 95% CrI, 0.87-2.30). DAPT was also associated with lower odds of symptomatic intracranial hemorrhage than alteplase (OR = 0.14, 95% CrI, 0.03-0.91). There were no significant differences between treatment groups regarding the other outcomes. For each outcome, the ranking for the best treatment was DAPT, then aspirin, and then IVT.</p><p><strong>Discussion/conclusion: </strong>This network meta-analysis suggests that DAPT may be the optimal treatment for acute nondisabling stroke, with higher odds of excellent functional outcome compared with IVT.Registration: PROSPERO ID: CRD42024522038.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241293323"},"PeriodicalIF":5.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: A multinational multicenter propensity score-weighted study.","authors":"Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Dhairya Lakhani, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Inayat Grewal, Benjamin Yq Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A Dmytriw","doi":"10.1177/23969873241291465","DOIUrl":"10.1177/23969873241291465","url":null,"abstract":"<p><strong>Background: </strong>Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.</p><p><strong>Methods: </strong>This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications.</p><p><strong>Results: </strong>A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, <i>p</i> = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, <i>p</i> = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, <i>p</i> = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups.</p><p><strong>Conclusion: </strong>EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241291465"},"PeriodicalIF":5.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for intracerebral hemorrhage by five specific bleeding sites: Japan Public Health Center-based Prospective Study.","authors":"Kenichi Ariyada, Kazumasa Yamagishi, Tomomi Kihara, Isao Muraki, Hironori Imano, Yoshihiro Kokubo, Isao Saito, Hiroshi Yatsuya, Hiroyasu Iso, Shoichiro Tsugane, Norie Sawada","doi":"10.1177/23969873241290680","DOIUrl":"10.1177/23969873241290680","url":null,"abstract":"<p><strong>Background: </strong>Evaluating the risk factors for intracerebral hemorrhage is indispensable for primary prevention. However, the pathogenesis varies depending on the bleeding site, and few prospective studies have explored risk factors in detail for each site.</p><p><strong>Participants and methods: </strong>The Japan Public Health Center-based Prospective Study is a prospective study comprising a population-based sample of Japanese adults in 1990 (Cohort I) and in 1993 (Cohort II). A total of 34,137 participants (11,907 men and 22,230 women) were enrolled in this study and followed up until 2009 for Cohort I and until 2012 for Cohort II. The association between risk factors (age, sex, blood pressure, serum cholesterol, triglycerides, blood glucose, body mass index, smoking, and drinking status) and intracerebral hemorrhage by its bleeding site (lobes, putamen, thalamus, cerebellum, and brainstem) was assessed using Cox proportional hazards analysis.</p><p><strong>Results: </strong>During a median 20-year follow-up, 571 intracerebral hemorrhage events occurred. Hypertension was associated with an increased risk of total intracerebral hemorrhage, but not lobar hemorrhage. The multivariable hazard ratio (95% confidence intervals) was 2.09 (1.75-2.50) for total intracerebral hemorrhage. In contrast, a low serum total cholesterol level was associated only with lobar hemorrhage (1.73 (1.01-2.96)). Heavy drinking was associated with the risk of total and putamen hemorrhage, and obesity was associated with the risk of putamen hemorrhage.</p><p><strong>Discussion and conclusion: </strong>The present study identified different risk factors depending on the bleeding site of intracerebral hemorrhage.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241290680"},"PeriodicalIF":5.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke-heart syndrome and early mortality in patients with acute ischaemic stroke using hierarchical cluster analysis: An individual patient data pooled analysis from the VISTA database.","authors":"Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Gregory Y H Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241290440","DOIUrl":"10.1177/23969873241290440","url":null,"abstract":"<p><strong>Background: </strong>The patient clinical phenotypes at particularly high risk for early cardiac complications after a recent acute ischaemic stroke (AIS), that is, stroke-heart syndrome (SHS), remain poorly defined. We utilised hierarchical cluster analysis to identify specific phenotypic profiles associated with this risk.</p><p><strong>Methods: </strong>We gathered data on patients with AIS from the Virtual International Stroke Trials Archive, a global repository of clinical trial data. We examined cardiac complications within 30 days post-stroke, including acute coronary syndrome, heart failure, arrhythmias and cardiorespiratory arrest. We employed hierarchical cluster analysis to define distinct phenotypic risk profiles. The incidence/risk of SHS and 90-day mortality were compared across these profiles.</p><p><strong>Results: </strong>We included 12,482 patients (mean age 69 ± 12 years; 55% male), yielding five phenotypes: Profile 1 ('<i>elderly and AF</i>'), Profile 2 ('<i>young and smoker</i>'), Profile 3 ('<i>young</i>'), Profile 4 ('<i>cardiac comorbidities</i>') and Profile 5 ('<i>hypertension with atherosclerotic comorbidities</i>'). Profiles 4 and 1 exhibited the highest risk for SHS (adjusted HR (95% CI): 2.01 (1.70-2.38) and 1.26 (1.05-1.51), respectively, compared to Profile 3), while Profiles 5 and 2 showed moderate risk and Profile 3 had the lowest risk. Although Profiles 1 and 4 were at the highest risk for most SHS presentations, Profile 5 had the highest risk for cardiorespiratory arrest (adjusted HR (95% CI): 2.99 (1.22-7.34)). The 90-day mortality risk was stratified by phenotype, with the highest risk observed in Profiles 5, and 4.</p><p><strong>Conclusions: </strong>Hierarchical cluster analysis effectively identified phenotypes with the highest risk of SHS and early mortality in patients with AIS.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241290440"},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The presence of a ghost infarct core is associated with fast core growth in acute ischemic stroke.","authors":"Mikito Saito, Hiroyuki Kawano, Takuya Adachi, Miho Gomyo, Kenichi Yokoyama, Yoshiaki Shiokawa, Teruyuki Hirano","doi":"10.1177/23969873241289320","DOIUrl":"10.1177/23969873241289320","url":null,"abstract":"<p><strong>Introduction: </strong>The overestimation of ischemic core volume by CT perfusion (CTP) is a critical concern in the selection of candidates for reperfusion therapy. This phenomenon is termed a ghost infarct core (GIC). Core growth rate (CGR) is an indicator of ischemic severity. We aimed to elucidate the association between GIC and CGR.</p><p><strong>Patients and methods: </strong>Consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy in our institute from March 2017 to July 2022 were enrolled. The initial ischemic core volume (IICV) was measured by pretreatment CTP, and the final infarct volume (FIV) was measured by diffusion-weighted imaging. A GIC was defined by IICV minus FIV > 10 ml. The CGR was calculated by dividing the IICV by the time from onset to CTP. Univariable analysis and a multivariable logistic regression model were used to evaluate the association between GIC-positive and CGR.</p><p><strong>Results: </strong>Of all 91 patients, 21 (23.1%) were GIC-positive. The GIC-positive group had higher CGR (14.2 [2.6-46.7] vs 4.8 [1.6-17.1] ml/h, <i>p</i> = 0.02) and complete recanalization (<i>n</i> = 15 (71.4%) vs 29 (41.4%), <i>p</i> = 0.02) compared to the GIC-negative group. On receiver-operating characteristic curve analysis, the optimal cutoff point of CGR to predict GIC-positive was 22 ml/h (sensitivity, 0.48; specificity, 0.85; AUC, 0.67). Multivariable logistic regression analysis showed that CGR ⩾ 22 ml/h (OR 6.44, 95% CI [1.59-26.10], <i>p</i> = 0.01) and complete recanalization (OR 3.72, 95% CI [1.14-12.08], <i>p</i> = 0.02) were independent predictors of GIC-positive.</p><p><strong>Conclusions: </strong>A GIC was associated with fast CGR in acute ischemic stroke. Overestimation of the initial ischemic core may be determined by core growth speed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241289320"},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10).","authors":"Cyril Dargazanli, Isabelle Mourand, Mehdi Mahmoudi, Laurence Poirier, Julien Labreuche, David Weisenburger-Lile, Benjamin Gory, Sébastien Richard, Célina Ducroux, Michel Piotin, Raphael Blanc, Ludovic Lucas, Gaultier Marnat, Mathilde Aubertin, Caroline Arquizan, Romain Bourcier, Lili Detraz, Stéphane Vannier, Maud Guillen, François Eugene, Gregory Walker, Ronda Lun, Dariush Dowlatshahi, Michel Shamy, Arturo Consoli, Vincent Costalat, Bertrand Lapergue, Benjamin Maïer, Adrien Guenego, Robert Fahed","doi":"10.1177/23969873241290442","DOIUrl":"10.1177/23969873241290442","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population.</p><p><strong>Methods: </strong>We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method.</p><p><strong>Results: </strong>One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04-6.90; <i>p</i> = 0.041).</p><p><strong>Conclusion: </strong>Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months.Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241290442"},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-recommended basic parameter adherence in neurocritical care stroke patients: Observational multicenter individual participant data analysis.","authors":"Anne Mrochen, Omar Alhaj Omar, Johann O Pelz, Dominik Michalski, Hermann Neugebauer, Dominik Lehrieder, Benjamin Knier, Corinna Ringmaier, Henning Stetefeld, Silvia Schönenberger, Min Chen, Hauke Schneider, Angelika Alonso, Hendrik Lesch, Andreas Totzeck, Friedrich Erdlenbruch, Benedikt Hiller, Norma J Diel, André Worm, Christian Claudi, Stefan T Gerner, Hagen B Huttner, Patrick Schramm","doi":"10.1177/23969873241289360","DOIUrl":"10.1177/23969873241289360","url":null,"abstract":"<p><strong>Introduction: </strong>Neurocritical care patients with neurovascular disease often face poor long-term outcomes, highlighting the pivotal role of evidence-based interventions. Although International Guidelines emphasize managing basic physiological parameters like temperature, blood glucose, blood pressure, and oxygen levels, physician adherence to these targets remains uncertain. This study aimed to assess adherence to guideline-based treatment targets for basic physiological parameters in neurocritical care.</p><p><strong>Patients and methods: </strong>This multicenter observational study was conducted across eight tertiary University Hospitals in Germany analyzed 474 patients requiring mechanical ventilation (between January 1st and December 31st, 2021). Adherence was defined as the rate of measurements within therapeutic ranges for systolic blood pressure (situation-adapted), mean blood pressure (MAP, 60-90 mmHg), glucose levels (80-180 mg/dl), body temperature (<37.5°C), partial arterial pressure of oxygen (PaO₂) 80-120 mmHg und partial arterial pressure of carbon dioxide (PaCO₂) 35-45 mmHg during the initial 96 h of hospitalization in 4 hour-intervals.</p><p><strong>Results: </strong>Overall, 70.7% of all measurements were within the predetermined therapeutic ranges including SBP (71.3%), temperature (68.3%), MAP (71.4%), PaO₂ (65.2%), PaCO₂ (75.0%) and blood glucose (80.7%).</p><p><strong>Discussion and conclusion: </strong>This multicenter study demonstrates adherence to guideline-based treatment targets, underscoring the high standards maintained by neurological intensive care units. Our study offers valuable insights into adherence to guideline-based treatment targets for neurocritical care patients in Germany. To improve patient care and optimize therapeutic strategies in neurovascular diseases, further research is needed to examine the impact of these adherence parameters on long-term outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241289360"},"PeriodicalIF":5.8,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensified post-stroke care improves long-term dysphagia recovery after acute ischemic stroke: Results from the STROKE CARD trial.","authors":"Anel Karisik, Vincent Bader, Kurt Moelgg, Lucie Buergi, Benjamin Dejakum, Silvia Komarek, Christian Boehme, Thomas Toell, Lukas Mayer-Suess, Simon Sollereder, Sonja Rossi, Patricia Meier, Gudrun Schoenherr, Johann Willeit, Peter Willeit, Wilfried Lang, Stefan Kiechl, Michael Knoflach, Raimund Pechlaner","doi":"10.1177/23969873241284123","DOIUrl":"10.1177/23969873241284123","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia is common after acute ischemic stroke and entails considerable morbidity and mortality. Here, we investigated the impact of intensified care on swallowing recovery after stroke.</p><p><strong>Patients and methods: </strong>In this secondary analysis of STROKE-CARD, a randomized intervention trial of intensified post-stroke care, dysphagia was assessed by speech therapists at admission for acute ischemic stroke, at hospital discharge, and after 12-months. Patients randomized to STROKE-CARD care additionally received a detailed dysphagia follow-up at 3-months, including a standardized dysphagia examination, instructions on further exercises and compensation mechanisms and, if necessary, referral for further speech therapy.</p><p><strong>Results: </strong>Dysphagia was present initially after stroke in 236 (16.6%; median age 82 (73-88), 44.1% female) of 1419 patients, with similar prevalence in both study groups at hospital admission (<i>p</i> = 0.239) and discharge (<i>p</i> = 0.870). At follow up, 14 (9.5%) of 147 in the intervention group and 18 (20.2%) of 89 in the control group suffered from persistent dysphagia (<i>p</i> = 0.020). There was better dysphagia recovery in the intervention group also under multivariable adjustment for age, sex, functional disability at 12-months, severe dysphagia at hospitalization, mode of feeding, cognitive impairment, thrombolysis, and stroke localization (odds ratio, 0.41, 95% confidence interval: 0.17 to 0.96).</p><p><strong>Discussion and conclusion: </strong>Intensified post-stroke care improved dysphagia recovery within 1 year after acute ischemic stroke, highlighting the potential of targeted interventions for enhancing stroke outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241284123"},"PeriodicalIF":5.8,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}